Will you be able to complete your ninety day employment review without a work interruption after you are hired? YES NO If you check No, please explain

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1 Lions Services, Inc A North Tryon, St. Charlotte, NC PH: FAX: EMPLOYMENT APPLICATION Position Applied For: (Specific position requested.) Date of Application: (As shown and spelled on SS card) Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Telephone Number: Alternate Number: How did you find out about this opening? Social Security Number: Can you perform the essential functions of this job with or without reasonable accommodation? (If you have questions about the functions of the job, please ask the interviewer before answering this question.) Have you worked for Lions Services before? (If yes, please give dates.) YES NO Have you been convicted of a criminal offense (felony or misdemeanor) in the last 7 years? If YES please explain: A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FOR EMPLOYMENT. On what date would you be available to work? Are you interested in working: PART TIME FULL TIME Salary desired: Will you be able to complete your ninety day employment review without a work interruption after you are hired? YES NO If you check No, please explain YES YES NO NO In case of Emergency notify: Name Address Phone # EDUCATION Name and Location of School Course of Study or Major # Of Years Completed Did you graduate? Diploma/Degree Year Graduated High School College Graduate Vocational Describe any specialized training, apprenticeships, licenses or skills: U.S. Military, National Guard, or Reserves NO YES Rank: REFERENCES: (Please list three professional references (former supervisors/co-workers) Name and Company Address/ Phone Number ADMI-FORM-003 Effective Date:10/12/17 Revision Level: 7 Page 1 of 3

2 Employment Application EMPLOYMENT HISTORY (Begin with current or most recent employer.) May we contact your present employer? YES NO Previous employers? YES NO 1. NAME OF EMPLOYER: Company Name: Address: Telephone Number: Position Held: Employment Dates: From To Job Duties: Name and Title of Supervisor Salary: Reason for leaving: 2. NAME OF EMPLOYER: Company Name: Address: Telephone Number Position Held Employment Dates: From To Job Duties: Name and Title of Supervisor Salary: Reason for leaving: 3. NAME OF EMPLOYER: Company Name: Address: Telephone Number Position Held Employment Dates: From To Job Duties: Name and Title of Supervisor Salary: Reason for leaving: Page 2 of 3

3 Employment Application Indicate your skills, equipment operation, experiences, abilities, etc. (if additional space is needed, continue on separate sheet.) # Years Skill Familiar? Proficient? Experience Sewing Machine Types: Single Needle Double Needle Bartack Serge Machine Home Sewing Machine Industrial Sewing Machines Items you have sewn (List below) Other Equipment/Machinery (List below) I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL, FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PREVIOUS NOTICE. I UNDERSTAND THAT THIS APPLICATION IS CONSIDERED CURRENT FOR TWELVE MONTHS. IF I WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THIS PERIOD I MUST FILL OUT AND SUBMIT A NEW APPLICATION. BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS. Signature Date: Name and telephone number of person completing this form if other than applicant: Interviewed by: Date: (For Agency Use) Remarks: Hired on: Position Hired: Salary Wages: Will Report to work on: For Department: Approved by: (Name and Title) LIONS SERVICES, INC IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL OR ETHNIC ORIGIN, AGE, DISABILITY, MARITAL STATUS, CITIZENSHIP, VETERAN STATUS, SEXUAL ORIENTATION, OR ANY OTHER OCCUPATIONALLY IRRELEVANT CRITERIA, OR OTHER STATUS PROTECTED BY LAW UNLESS LEGALLY REQUIRED. Page 3 of 3

4 DO NOT STAPLE ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by ( Employer ) at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Verified First, 1550 South Tech Lane, Suite 200, Meridian, Idaho 83642; Tel. # ; and/or Employer. I agree that a facsimile ( fax ), electronic or photographic copy of this Authorization shall be as valid as the original. New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Employer, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Employer by contacting the consumer reporting agency identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law. New York City applicants only: You acknowledge and authorize the Employer to provide any notices required by federal, state or local law to you at the address(es) and/or address(es) you provided to the Employer. Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Minnesota and Oklahoma applicants only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Employer. PLEASE COMPLETE ALL FIELDS BELOW Last Name First Name Middle Name check box if no middle name Social Security Number* ###-##-#### Date of Birth* month/date/year Address required Driver s License Number Issuing State* Former Names/Aliases separate aliases with comma CURRENT ADDRESS FORMER EMPLOYER Street Apt/Unit Company City, State City State Zip Position Dates of Employment *This information will be used for background screening purposes only and will not be used as hiring criteria. Applicant Signature Date Revision 07/26/17

5 DO NOT STAPLE APPLICANT COPY A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT Para información en español, visite o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You many limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt out with the nationwide credit bureaus at OPTOUT ( ). You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit APPLICANT COPY

6 DO NOT STAPLE APPLICANT COPY A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: TYPE OF BUSINESS 1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: 2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions CONTACT a. Consumer Financial Protection Bureau 1700 G Street, N.W. Washington, DC b. Federal Trade Commission: Consumer Response Center FCRA Washington, DC (877) a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX b. Federal Reserve Consumer Help Center P.O. Box Minneapolis, MN c. FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Aviation Consumer Protection Division Department of Transportation 1200 New Jersey Avenue, S.E. Washington, DC Creditors Subject to the Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 395 E Street, S.W. Washington, DC Creditors Subject to the Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area supervisor 6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 409 Third Street, S.W., 8th Floor Washington, DC Brokers and Dealers Securities and Exchange Commission 100 F Street, N.E. Washington, DC Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above Farm Credit Administration 1501 Farm Credit Drive McLean, VA FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center FCRA Washington, DC (877) APPLICANT COPY

7 Lions Services, Inc. Employment Data Record Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Refusal to provide this information will not subject you to adverse treatment. This data is for periodic government reporting and will be kept in a confidential file separate from the Application for Employment. Election of Affirmative Action: Yes, I choose to be involved. No, I do not choose to be involved. Signature of Applicant Date Last Name First Name Middle Initial Address Street City State Zip Social Security Number Position Applied For: How did you hear about his position? Please Check one. Newspaper Ad Recruiter Current Employee Other Explain Below: Government Agencies require periodic reports on the sex, and ethnicity status of applicants. This data is for analysis and affirmative action only. Check one: _ Male _ Female Check one of the following: Race / Ethnic Group _ Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. _ White (Not Hispanic or Latino") - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. _ Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. _ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. _ Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. _ Race missing or unknown - Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant- Disposition For Company Use Only Hired Rejected Offer Did Not Hire Reason Form: ADMI-FORM-005 Effective Date: 3/21/14 Reviewed by: REDACTED Revision Level: 2 Approved by: REDACTED

8 Page 1 of 1 Voluntary Self-Identification of Veteran Status Lions Services, Inc. is a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended (VEVRAA), which requires government contractors to take affirmative action to employ and advance in employment the following protected veterans: Disabled Veteran: Veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administrated by the Secretary of Veterans Affairs, or a person who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran: Any veteran during the 3 year period beginning on the date of such veteran s discharge or release from active duty in the U.S. military, ground, naval, or air service. Active Duty Wartime or Campaign Badge Veteran: A veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. Armed Forces Service Medal Veteran: A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order Protected veterans may have additional rights under USERRA the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. DOL s Veterans Employment and Training Service, toll-free, at USA-DOL. If you believe you belong to any of the categories of protected veterans listed above please indicate on the bottom of this form by checking the appropriate box. As a contractor subject to VEVRAA, we request this information to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential. Please check the appropriate box: I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE I AM NOT A PROTECTED VETERAN Your Name: Date: AFFIRMATIVE ACTION POLICY: Lions Services, Inc. is an affirmative action employer. All personnel actions, including recruitment, hiring, training, and promoting persons in all job titles, will be administered without regard to veteran status. All employment decisions are based solely on valid job requirements. Our affirmative action program contains policies and procedures that assure compliance with our VEVRAA obligations.

9 Voluntary Self-Identification of Disability Why are you being asked to complete this form? Form CC-305 OMB Control Number Expires Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive compulsive disorder Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchair Diabetes Epilepsy Schizophrenia Muscular dystrophy Missing limbs or partially missing limbs Intellectual disability (previously called mental retardation) Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON T HAVE A DISABILITY I DON T WISH TO ANSWER Your Name Today s Date

10 Voluntary Self-Identification of Disability Reasonable Accommodation Notice Form CC-305 OMB Control Number Expires Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor s Office of Federal Contract Compliance Programs (OFCCP) website at PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.